Northwest American Indians are a drastically understudied and underserved group, at ilsk for multiple health problems induding poor maternal health during and after pregnancy. American Indians living in the Northwest have very high rates of poor maternal and irtfant outcomes. This application, in response to RFA HHS-2009-HIS-NARCHV-O001, involves a 4-year developmental project to explore matemal health behaviors, maternal substance use, risk factors for substance use during and after pregnancy, and protective factors that support healthy matemal behaviors. Findings will assist the research team in designing a culturally appropriate and feasible intervention program for American Indian mothers living in the Northwest. Building upon existing preliminary epidemiological and surveillance data as well as tribal support, this study proposes five innovative and significant aims. First, we will conduct qualitative formative research involving 4 focus groups and 25 key infomiant interviews with mothers aged 18-55, Native health providers, elder/traditional healers, and Native youth (aged 15-25). Second, we will conduct structured survey interviews with 100 American Indian community members. With these inten/iew data, we will establish preliminary baseline data related to matemal health outcomes, protective health tjehaviors, risk factors for substance use during and after pregnancy, and social support for mothers. Third, we will develop and manualize a culturally-based intervention targeting adult American Indian mothers in the Northwest. Fourth, we will translate and disseminate the findings to the tribe and prepare translational materials for community members and service providers. Fifth, throughout the course ofthe study, we will work to expand the research infrastructure at Lummi Tribal Health Clinic and to increase research capacity in the tribal community.